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While previous research has exclusively focused on this phenomenon among adults, this study examines crack pipe sharing among street\u2010involved youth.<\/jats:p><\/jats:sec>Design and Methods<\/jats:title>From M<\/jats:styled-content>ay 2006 to M<\/jats:styled-content>ay 2012, data were collected from the At\u2010Risk Youth Study, a cohort of street\u2010involved youth aged 14\u201326 in V<\/jats:styled-content>ancouver, C<\/jats:styled-content>anada. Survey data from active crack smokers were analysed using generalised estimating equations logistic regression.<\/jats:p><\/jats:sec>Results<\/jats:title>Over the study period, 567 youth reported smoking crack cocaine and contributed 1288 observations, among which 961 (75%) included a report of crack pipe sharing. In multivariate analysis, factors that were associated with crack pipe sharing included difficulty accessing crack pipes [adjusted odds ratio (AOR<\/jats:styled-content>)\u2009=<\/jats:italic>\u20091.58, 95% confidence interval (CI<\/jats:styled-content>) 1.13\u20132.20]; homelessness (AOR<\/jats:styled-content>\u2009=<\/jats:italic>\u20091.87, 95% CI<\/jats:styled-content> 1.43\u20132.44); regular employment (AOR<\/jats:styled-content>\u2009=<\/jats:italic>\u20091.53, 95% CI 1.15\u20132.04); daily non\u2010injection crystal methamphetamine use (AOR<\/jats:styled-content>\u2009=<\/jats:italic>\u20092.04, 95% CI<\/jats:styled-content> 1.11\u20133.75); daily crack smoking (AOR<\/jats:styled-content>\u2009=<\/jats:italic>\u20091.37, 95% CI<\/jats:styled-content> 1.01\u20131.85); encounters with the police (AOR<\/jats:styled-content>\u2009=<\/jats:italic>\u20091.42, 95% CI<\/jats:styled-content> 1.01\u20131.99); and reporting unprotected sex (AOR<\/jats:styled-content>\u2009=<\/jats:italic>\u20091.95, 95% CI<\/jats:styled-content> 1.47\u20132.58).<\/jats:p><\/jats:sec>Discussion and Conclusions<\/jats:title>The prevalence of crack pipe sharing was high among our sample and independently associated with structural factors including difficulty accessing crack pipes and homelessness. Crack pipe sharing was also associated with high\u2010intensity drug use and a number of other markers of risk and vulnerability. Collectively, these findings highlight opportunities for health services to better engage with this vulnerable group and reduce this risky behaviour.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dar.12180","type":"journal-article","created":{"date-parts":[[2014,7,25]],"date-time":"2014-07-25T12:59:22Z","timestamp":1406293162000},"page":"259-266","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Crack pipe sharing among street\u2010involved youth in a C<\/scp>anadian setting"],"prefix":"10.1111","volume":"34","author":[{"given":"Tessa","family":"Cheng","sequence":"first","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS Vancouver Canada"},{"name":"Faculty of Health Sciences Simon Fraser University Burnaby Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Wood","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS Vancouver Canada"},{"name":"Faculty of Medicine University of British Columbia Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Nguyen","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Montaner","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS Vancouver Canada"},{"name":"Faculty of Medicine University of British Columbia Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Kerr","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS Vancouver Canada"},{"name":"Faculty of Medicine University of British Columbia Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kora","family":"DeBeck","sequence":"additional","affiliation":[{"name":"British Columbia Centre for Excellence in HIV\/AIDS Vancouver Canada"},{"name":"School of Public Policy Simon Fraser University Burnaby Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,7,25]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Public Health Agency of Canada. 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